Articulation locking mechanisms for end effectors and methods of use

ABSTRACT

A medical device includes an end effector at a distal end of the medical device, an actuator coupled to a proximal end of the end effector, a pivot arm pivotally coupled to the end effector distal of the proximal end of the end effector, where actuation of the actuator pivots the end effector relative to the pivot arm, and a lock on the end effector and the pivot arm, where the lock has a first state permitting the end effector to pivot relative to the pivot arm and a second state restricting the end effector from pivoting relative to the pivot arm.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority from U.S. Provisional Application No. 62/969,738, filed on Feb. 4, 2020, which is incorporated by reference herein in its entirety.

TECHNICAL FIELD

This disclosure relates to minimally invasive (e.g., endoscopic and/or laparoscopic) medical devices and related methods of use. In embodiments, the disclosure relates to one or more locking mechanisms for end effectors, e.g., tissue fastening devices such as stapler devices, and related methods of use, among other aspects.

BACKGROUND

Technological developments have given users of medical systems, devices, and methods, the ability to conduct increasingly complex procedures on patients. The grasping and/or coupling of tissue in a patient's body, for example, may be performed by surgical devices that grasp or clamp tissue between opposing jaw structures and then fasten or cut the tissue. A drawback of these systems may include, for example, maintaining a desired orientation of the jaws of an end effector during a procedure, such as a stapling procedure, a cutting procedure, and/or additional medical procedures. For example, to access tissue, an end effector may be articulated about a pivot point. During a cutting or a fastening step, actuation of the cutting and/or fastening device may cause the end effector to pivot from the selected orientation to a different, undesired orientation. Thus, tissue may not be properly stapled and/or cut, which may increase therapy time and/or cost, may cause undesired or incomplete fastening of tissues, and/or may require additional therapy/intervention at the target site. This disclosure may solve one or more of these problems or other problems in the art. The scope of the disclosure, however, is defined by the attached claims and not the ability to solve a specific problem.

SUMMARY OF THE DISCLOSURE

According to an aspect, a medical device includes an end effector at a distal end of the medical device, an actuator coupled to a proximal end of the end effector, a pivot arm pivotally coupled to the end effector distal of the proximal end of the end effector, where actuation of the actuator pivots the end effector relative to the pivot arm, and a lock on the end effector and the pivot arm, where the lock has a first state permitting the end effector to pivot relative to the pivot arm and a second state restricting the end effector from pivoting relative to the pivot arm.

The end effector may include a first jaw, and a second jaw hingedly connected to the first jaw and configured to move between an open position and a closed position.

The locking mechanism may include a plurality of teeth at a distal end of the pivot arm, wherein the plurality of teeth may define a plurality of spaces, and a tab connected to the end effector, wherein the tab may be configured to engage a space from the plurality of spaces in the second state.

The lock is in the first state when the pair of jaws is in the open position, and the lock is in the second state when the pair of jaws is in the closed position.

The end effector may be configured to pivot independently of a movement of the first jaw relative to the second jaw.

The locking mechanism may include a sprocket connected to the pivot arm, wherein the sprocket may include a plurality of teeth defining a plurality of spaces, and a pawl pivotally connected at the proximal end of the end effector and may be configured to engage the plurality of spaces.

The medical device may further comprise a wire connected to the pawl and extending in a proximal direction, wherein the pawl may be biased into engagement with the plurality of spaces of the sprocket, and wherein moving the wire in the proximal direction may be configured to pivot the pawl away from the sprocket to disengage the pawl from the plurality of spaces.

The sprocket may be arc shaped, and wherein a convex arrangement of the plurality of spaces of the sprocket may face proximally.

The locking mechanism may include a ball-nose spring plunger.

The ball-nose spring plunger may include a spring coupled at a first end of the end effector, wherein the spring may be configured to extend from the first end and compress along a compression axis, a plurality of detents fixed to the pivot arm, and a ball bearing connected to the spring and selectively engaging each of the plurality of detents, wherein the ball bearing may be configured to move along the compression axis.

The ball bearing may be configured to move from a first detent of the plurality of detents to an adjacent, second detent of the plurality of detents as the end effector pivots about the pivot arm, and wherein the spring may be configured to be compressed from a first position to a second position and expand back to the first position as the ball bearing moves from the first detent to the second detent.

The medical device may further comprise an actuation wire fixed to a proximal end of the end effector, wherein actuation of the actuation wire may be configured to move the end effector between an open position and a closed position.

The pivot arm may include a first opening at a proximal end of the pivot arm, a second opening in a sidewall of the pivot arm, and a lumen extending from the first opening to the second opening. The actuator may be configured to extend through each of the first opening, the lumen, and the second opening.

The medical device may further comprise a handle assembly configured to actuate the end effector and the locking mechanism, wherein a proximal end of the actuator may be connected to a distal end of the handle assembly, and a catheter may include at least one lumen and may extend distally from the handle assembly, wherein the actuator may extend through the at least one lumen, and wherein the pivot arm may be fixed to a distal end of the catheter.

A pivot angle may be defined between a longitudinal axis of the end effector and a longitudinal axis of the pivot arm, wherein a distal movement of the actuator may be configured to increase the pivot angle, and wherein a proximal movement of the actuator may be configured to decrease the pivot angle.

According to another aspect, a medical device comprises an elongated member, an end effector connected to a distal end of the elongated member, wherein the end effector may include a tab, and a catheter including a plurality of spaces at a distal end, wherein the tab may be configured to selectively engage the plurality of spaces to inhibit pivotal movement of the end effector.

The elongated member may extend through an opening of the catheter proximally of a distal end of the catheter, and wherein the end effector may be pivotally coupled to the catheter distally of the opening.

According to another aspect, a medical method includes advancing an end effector and a pivot arm to a target site within a patient, pivoting the end effector relative to the pivot arm about a pivot axis until a desired orientation of the end effector is achieved, locking the orientation of the end effector relative to the pivot arm, and performing an operation via the end effector.

The end effector may include a first jaw, and a second jaw hingedly connected to the first jaw, wherein the end effector may include an open configuration and a closed configuration, and wherein a distance between distal ends of the first jaw and the second jaw may be greater in the open configuration than a distance between the distal ends of the first jaw and the second jaw in the closed configuration.

When the end effector is in the closed configuration, the end effector may be locked relative to the pivot arm, and when the end effector is in the open configuration, the end effector may be unlocked relative to the pivot arm.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate various exemplary embodiments and together with the description, serve to explain the principles of the disclosed embodiments.

FIG. 1 is a schematic view of a tissue fastening device according to an embodiment;

FIGS. 2A and 2B are views of an end effector of the fastening device of FIG. 1 , according to an embodiment;

FIG. 2C is a view of a pivot arm of the end effector of FIGS. 2A and 2B;

FIGS. 3A and 3B are views of an end effector of the fastening device of FIG. 1 , according to an embodiment;

FIGS. 4A and 4B are views of an end effector of the fastening device of FIG. 1 , according to another embodiment;

FIG. 5A is a view of an end effector of the fastening device of FIG. 1 , according to another embodiment; and

FIG. 5B is a view of a locking mechanism of the end effector of FIG. 5A.

DETAILED DESCRIPTION

This disclosure is described with reference to exemplary medical systems and medical tools for accessing a target site, for example, for grasping, cutting, and/or stapling tissue. This may provide improved medical tool functionality and/or may assist medical professionals to improve cutting and/or fastening of tissue. However, it should be noted that reference to any particular device and/or any particular procedure is provided only for convenience and not intended to limit the disclosure. A person of ordinary skill in the art would recognize that the concepts underlying the disclosed devices and application methods may be utilized in any suitable procedure, medical or otherwise. This disclosure may be understood with reference to the following description and the appended drawings, wherein like elements are referred to with the same reference numerals.

For ease of description, portions of the disclosed devices and/or their components are referred to as proximal and distal portions. It should be noted that the term “proximal” is intended to refer to portions closer to a user of the devices, and the term “distal” is used herein to refer to portions further away from the user. Similarly, “extends distally” indicates that a component extends in a distal direction, and “extends proximally” indicates that a component extends in a proximal direction. Further, as used herein, the terms “about,” “approximately,” and “substantially” indicate a range of values within +/−10% of a stated or implied value. Additionally, terms that indicate the geometric shape of a component/surface refer to exact and approximate shapes.

Embodiments of this disclosure may be used to cut and/or fasten tissue in an endo-luminal space, or facilitate the process thereof. According to an example, the fastening device may be a tissue stapling apparatus, which may include a resection or cutting mechanism (e.g., an integrated knife) and a stapling mechanism (e.g., a stapler). The fastening device may be delivered through an endoscope working channel to the target tissue site. All or parts of the fastening device could be metallic (such as stainless steel, titanium, or cobalt chrome), plastic (such as polyetheretherketone (PEEK) or the like), or include a shape memory metal (such as nitinol), a shape memory polymer, a polymer, or any combination of materials. While reference is made herein to a fastening device, the described locking members may be used with any device pivotally connected to a distal end of a catheter, sheath, tube, or the like. The locking members may prevent pivotal movement of an end effector or other device pivotally connected to the distal end of, e.g., the catheter. This may improve an operation of the end effector. For example, preventing a pivotal rotation of a stapler during stapling may improve the connection between the adjacent tissues.

FIG. 1 shows an apparatus 10 in accordance with an example of this disclosure. Apparatus 10 may be a surgical stapling apparatus configured to engage body tissue, and apply a plurality of fasteners thereto during minimally invasive procedures, such as laparoscopic or endoscopic procedures. In some embodiments apparatus 10 may be a suturing apparatus to delivering a suture for tissue closure during minimally invasive surgical procedures. Apparatus 10 may be used to apply a suture, clips, or other fasteners, but will be primarily discussed in the context of grasping tissue in preparation of performing additional procedures to the tissue, e.g., stapling and/or cutting the tissue.

As illustrated in FIG. 1 , apparatus 10 includes a handle assembly 30 at a proximal end, an end effector 100 at a distal end, and an elongated body 50 (e.g., a catheter or the like) connecting a distal end of handle assembly 30 to a proximal end of end effector 100 (as will be explained herein, end effector 100 may include a stapler device 110). Elongated body 50 may extend any length suitable for endoscopic or laparoscopic procedures, and may be configured to be positioned within a working channel of an endoscope. Alternatively, elongated body 50 may extend along an outer surface of the endoscope if, for example, the endoscope includes only a single lumen and/or a diameter of the lumen(s) of the endoscope are too small to receive elongated body 50. Elongated body 50 may be detachable from handle assembly 30 to facilitate insertion of elongated body 50 into a working channel of an endoscope or a channel of another device, for example by backloading elongated body 50 into the working channel. In some examples, elongated body 50 may be flexible, steerable, and/or may be rotatable about its axis. Elongated body 50 may include a lumen (or multiple lumens) for positioning actuation wires within, for actuating end effector 100 via handle assembly 30 or actuating any other portion of apparatus 10. Elongated body 50 may be configured to receive a plurality of actuation wires or a single actuation wire. In some examples, elongated body 50 may be fixedly coupled to end effector 100, and in other examples elongated body 50 may be removably or releasably coupled to end effector 100. Unless stated otherwise, any wire or actuation device described herein may extend from handle assembly 30 to end effector 100 via a lumen of elongated body 50. Alternatively, or additionally, one or more of these actuation wires or devices may extend from handle assembly 30 to end effector 100 outside of (e.g., adjacent to) elongated body 50. A catheter 55 (or any other sheath) including a lumen may extend distally from a distal end of handle assembly 30. Elongated body 50 may be disposed within the lumen of catheter 55 and may move relative to catheter 55. While catheter 55 is shown with a curved region in FIG. 1 , catheter 55 may be a straight sheath (e.g., such as a hypotube) having a rigidity sufficient to be moved proximally and distally within the body. Additionally, FIGS. 2A-2C, 3A, 3B, 4A, 4B, 5A, and 5B may be shown without catheter 55 attached to the proximal end of a pivot arm 60 for ease of understanding (e.g., to visualize elongated body 50).

Handle assembly 30 may include a handle 32 and a body 34. Handle 32 may include a fixed portion 32 a and an actuator portion 32 b. Fixed portion 32 a of handle 32 may be fixedly coupled to body 34. Actuator portion 32 b may include a circular or oval portion or ring for positioning a user's finger within, which may assist a user in holding handle assembly 30. In some examples, actuator portion 32 b of handle 32 may be an actuator which may be pivotally coupled to body 34 and movable relative to fixed portion 32 a of handle 32. In some examples, actuator portion 32 b of handle 32 may be coupled to a proximal portion of an actuation wire, such as an actuation wire 40 a, via an adjustable coupler 36, as will be described herein. An anvil 120 of stapler device 110 may be actuated via actuation wire 40 a, which extends between stapler device 110 and handle assembly 30. In other examples, actuator portion 32 b of handle 32 may be configured to control any other mechanism of apparatus 10, such as operating an articulation lock of end effector 100, actuation of the deployment of staples from stapler device 110, or the like. It will be understood that wire 40 a may have sufficient rigidity to be pushed in the distal direction and pulled in the proximal direction.

In some examples, handle assembly 30 may include a moveable cover 38 pivotally coupled to housing 34 at pivot point 38 b. In FIG. 1 , cover 38 is shown in an open position, exposing the internal portions of body 34. Cover 38 may be coupled to a proximal portion of body 34 and may cover the internal components of handle assembly 30 when positioned in a closed configuration, e.g., when a distalmost end 38 a of cover 38 faces a surface 34 a of body 34. Cover 38 may be positioned to cover the internal components of body 34 (e.g., a closed configuration) via a coupling mechanism at a distal portion of cover 38 and a distal portion of handle assembly 30, such as a snap-fit mechanism or the like. When in the closed configuration, cover 38 may form a pair of slots in body 34 (not shown). When the distal portion of cover 38 is uncoupled from the distal portion of body 34, a user may rotate or pivot cover 38 at pivot point 38 b in order to access to the internal components of handle assembly 30.

Handle assembly 30 may include one or more adjustable couplers 36, 39, which may be configured to receive a portion of an actuation wire, such as actuation wire 40 a. Any of adjustable couplers 36, 39 may be a vice which is moveable in order to clamp down onto actuation wire 40 a and fixedly couple actuation wire 40 a to the adjustable couplers 36, 39. In some examples, adjustable couplers 36, 39 may be moveable via a screw to adjust couplers 36, 39 and couple or uncouple actuation wire 40 a from couplers 36, 39. Couplers 36, 39 may be used in the movement of additional wires described herein.

Adjustable coupler 39 may be coupled to longitudinal actuator 31 and moveable longitudinally via translating longitudinal actuator 31 within body 34. Longitudinal actuator 31 may be partially positioned within housing 34 and may be slidable longitudinally within the two slots formed when cover 38 is positioned over the internal components of handle assembly 30. Longitudinal actuator 31 may include a pair of opposing circular or oval portions or rings, with each circular portion defining an aperture for a user to position a respective finger within. In some examples, longitudinal actuator 31 may be coupled to an actuation wire (not shown), such as via adjustable coupler 39 or via a different coupler within body 34, and may be configured to control staple deployment from stapler device 110. In other examples, longitudinal actuator 31 may be configured to control any other mechanism of apparatus 10, such as actuation of an anvil 120 of stapler device 110, actuation of a locking mechanism associated with end effector 100, or the like.

With continued reference to FIG. 1 , end effector 100 includes stapler device 110 which may be pivotally coupled to the distal end of elongated body 50. For example, a connector 52 at a distal end of elongated body 50 may be pivotally attached to a proximal end of stapler device 110 via a pin 52 a or the like. A pivot arm 60 may be pivotally attached to a side of a body 130 of stapler device 110 via a pin 60 a. For example, one or more protrusions 131 may extend from the side of body 130 and may receive pin 60 a through an opening in protrusion 131, thereby fixing pin 60 a relative to protrusion 131. Pin 60 a defines a pivot axis of stapler device 110 relative to pivot arm 60. Pin 60 a may also be received in an opening 66 at a distal end of pivot arm 60 (FIG. 2C), which may allow stapler device 110 to pivot relative to pivot arm 60. Pivot arm 60 may be fixedly attached to a distal end of catheter 55 by ultrasonic welding, adhesive, crimping, or the like. This may prevent pivot arm 60 from moving when elongated member 50 is moved relative to catheter 55 and/or pivot arm 60, as will be described herein. For ease of understanding, catheter 55 is shown only in FIG. 1 .

As shown in FIG. 2A, pivot arm 60 may include an opening 62 at a proximal end. Opening 62 may be connected to a lumen extending from the proximal end to the distal end of arm 60. A slot 65 (e.g., an opening) (FIG. 2C) may be formed in a side of pivot arm 60 and may be connected to the lumen of pivot arm 60. Slot 65 may be oval, rectangular, or any other suitable shape. Opening 62, the lumen of pivot arm 60, and slot 65 may be sized and shaped to receive a portion of elongated body 50, such that elongated body 50 may enter pivot arm 60 via opening 62 and extend out of slot 65. As will be described herein, movement of elongated body 50 relative to pivot arm 60 may cause stapler device 110 to rotate relative to pivot arm 60. Pivot arm 60 shown in FIG. 2C, or aspects of pivot arm 60 including slot 65, may be used with any end effector described herein. While pivot arm 60 is shown as a rectangular prism, pivot arm 60 may be any shape, including a cylinder, a rectangular prism with rounded edges, or the like.

Anvil 120 may be rotatably or pivotally coupled to body 130 via pin 120 a (pin 120 a may define a pivot axis). Anvil 120 and body 130 may be collectively referred to as jaws, grasping elements, and/or opposing members. Anvil 120 may extend distally towards a distal end of stapler device 110 from pin 120 a. In some examples, anvil 120 may be rotatably biased about pin 120 a and may be biased in an open configuration. For example, a distal end 124 of anvil 120 may biased away from body 130 using a spring or the like, thereby creating a space between distal end 124 of anvil 120 and a distal portion of body 130. Anvil 120 may rotate about pin 120 a and may contact or may approach body 130 in a closed position, e.g., to retain tissue between anvil 120 and body 130. In some examples, body 130 may include a channel that supports a cartridge of staples or other fastening devices (not shown). The closed position of anvil 120 may provide a surface for which staples may be driven against when ejected from the cartridge of stapler device 100. The cartridge may contain a plurality of surgical fasteners, such as staples, and the fasteners may be deployed from the cartridge when under the influence of a driving force exerted by an actuation sled or other actuation mechanism. Suitable staplers and associated actuation mechanisms are described in commonly-owned U.S. Provisional Patent Application No. 62/812,538, filed Mar. 1, 2019, the complete disclosure of which is incorporated herein by reference.

With reference to FIGS. 2A and 2B, pin 120 a may extend from a side of anvil 120, and pin 120 a may be disposed in a slot 136 on a side of body 130. For example, slot 136 may be disposed in an upper extension of body 130. In addition to pivoting about pin 120 a, anvil 120 may move in a longitudinal direction via pin 120 a and slot 136. For example, pin 120 a of anvil 120 may move within slot 136, which has a generally oval shape and extends in a longitudinal direction along a longitudinal axis. Slot 136 may be any shape, and may alternatively be a hole that fixes a longitudinal position of pin 120 a. In the embodiment shown in FIGS. 2A and 2B, when pin 120 a is located at a distal end of slot 136, anvil 120 may be positioned in the open configuration, and anvil 120 may be in the closed position when pin 120 a is positioned at a proximal end of slot 136. Wire 40 a may be attached at a proximal end 122 of anvil 120 via an attachment mechanism 122 a. Proximal movement of wire 40 a may cause anvil 120 to move proximally, which may cause anvil 120 to rotate about pin 120 a into the closed position. Distal movement of wire 40 a may cause anvil 120 to move distally, which may cause anvil 120 to rotate about pin 120 a into the open position.

FIG. 2B illustrates a top view of end effector 100 in the open configuration. A locking tab 126 is connected to anvil 120 via pin 120 a and a second pin 120 b, distal of pin 120 a. Through those connections locking tab 126 moves with anvil 120. It will be understood that locking tab 126 may be connected to anvil 120 via any other mechanism known in the art. According to an example, pin 120 b may engage a second slot, distal to slot 136, in the closed configuration, which may lock anvil 120 in the closed configuration.

Pivot arm 60 may include a pivot head 64 at the distal end thereof. Pivot head 64 may include a plurality of teeth 64 a defining a plurality of spaces 64 b therebetween. Locking tab 126 may engage spaces 64 b, as will be described herein. Teeth 64 a and spaces 64 b may be spaced apart radially about a circumference of pivot head 64 (FIG. 2C) such that stapler device 110 may be locked at an angle relative to pivot arm 60. For example, an angle α is defined as an angle between the longitudinal axis A-A of stapler device 110 and the longitudinal axis B-B of pivot arm 64. When a is 0 degrees, pivot arm 60 may be approximately parallel to stapler device 110 (axes A-A and B-B are approximately parallel), and when a is 90 degrees, pivot arm 60 may be approximately perpendicular to stapler device 110 (axes A-A and B-B are approximately perpendicular). According to an example, teeth 64 a and spaces 64 b may be spaced such that stapler device 110 may be locked at an orientation relative to pivot arm 60 such that a may be one of approximately 0 degrees, approximately 30 degrees, approximately 60 degrees, and approximately 90 degrees. It will be understood that a is not limited to these angles. The number of teeth 64 a and spaces 64 b, and their spacing, may determine the various angles α of locking stapler device 110 relative to pivot head 64. For example, teeth 64 a may be positioned on pivot head 64 to change the angle of a. Further, the number of teeth 64 a is not limited to three teeth 64 a, as shown in FIGS. 2A and 2B, and may be chosen based on the number of designed locking angles.

FIGS. 3A and 3B illustrate anvil 120 in the closed configuration. In the closed configuration, anvil 120 has rotated about pin 120 a such that distal end 124 of anvil 120 is closer to body 130 than in the open configuration. As shown in FIG. 3B, locking tab 126 may communicate with teeth 64 a in the closed position to prevent relative rotational or pivotal movement between stapler device 110 and pivot arm 60. For example, a proximal portion of locking tab 126 may be positioned between adjacent teeth 64 a in the closed configuration, which may prevent stapler device 110 from rotating relative to pivot arm 60.

A method of operating end effector 100 will now be described. End effector 100 may be advanced to a target site in a body via an incision or a natural orifice. End effector 100 is advanced in a closed configuration and subsequently opened via actuation of actuation wire 40 a. In the open configuration, tissue at the target site may be placed between anvil 120 and body 130 (e.g., jaws) of stapler device 110, via any suitable method. To properly orient stapler device 110, a user may push distally or pull proximally on elongated body 50 to cause stapler device 110 to pivot about the axis defined by pin 60 a until a desired orientation of stapler device 110 relative to pivot arm 60 is achieved (e.g., a desired angle α). The desired positioning/orientation of stapler device 110 may be assisted by an imaging device associated, for example, with an endoscope through which apparatus 10 is inserted. After the desired orientation is achieved, the user may move wire 40 a in a proximal direction (e.g., pull on wire 40 a) and thereby move anvil 120 into the closed configuration using, e.g., handle assembly 30. As anvil 120 moves into the closed configuration, locking tab 126 may engage spaces 64 b in a locked position and may prevent rotation of stapler device 110 about the axis defined by pin 60 a. While in this locked position, the user may perform additional procedures, e.g., stapling, cutting, or other procedures on the tissue. Once the procedure is complete, the user may move (e.g., push) wire 40 a in a distal direction, which may cause anvil 120 to move to the open position, thereby disengaging locking tab 126 from spaces 64 b. The user may then rotate stapler device 110 to a new, different orientation relative to pivot arm 60. If desired, the user may relock stapler device 110 in the new orientation by repeating this procedure or the user may remove the apparatus from the body.

A locking mechanism for an end effector 100′ according to another example is shown in FIGS. 4A and 4B. End effector 100′ is similar to end effector 100, and may include stapler device 110 pivotally connected to pivot arm 60. Locking mechanism may include a pawl 66′ and a sprocket 64′ having a plurality of teeth 64 a′. Spaces 64 b′ are defined between adjacent teeth 64 a′. Sprocket 64′ may be rigidly connected to pivot arm 60 and may have an arc shape with a convex surface facing a proximal end of the end effector 100. Pawl 66′ may be pivotally attached to body 130 of end effector 100 by a pin 66 a′. A biasing member, e.g., a spring, may bias pawl 66′ in a distal direction, e.g., toward sprocket 64′. Pawl 66′ may engage spaces 64 b′ to lock stapler device 110 in a desired orientation relative to pivot arm 60. For example pawl 66′ may sit in any one of spaces 64 b′ between adjacent teeth 64 a′. An actuation wire 40 b may be attached to an end of pawl 66′ opposite an end of pawl 66′ connected to pin 66 a′. Actuation wire 40 b may be similar to wire 40 a and may be moved proximally (e.g., pulled) and distally (e.g., pushed) to cause pawl 66′ to pivot about pin 66 a′.

As with end effector 100, end effector 100′ may be locked such that an orientation of stapler device 110 relative to pivot arm 60 is locked at one or more positions based on the number of teeth 64 a′ and spaces 64 b′, and the spacing of teeth 64 a′ and spaces 64 b′. For example, when a is 0 degrees, pivot arm 60 may be parallel to end effector 100′ (axes A-A and B-B are approximately parallel), and when a is 90 degrees, pivot arm 60 may be perpendicular to end effector 100′ (axes A-A and B-Bare approximately perpendicular). It will be understood that angle α is not limited to these angles. Further, teeth 64 a′ and spaces 64 b′ are not limited to the number shown in FIGS. 4A and 4B. The number of teeth 64 a′ and the number of spaces 64 b′ may be selected based on the number of possible positions stapler device 110 may be locked relative to pivot arm 60. For example, teeth 64 a′ define seven spaces 64 b′ that provide different angles α between axes A-A and B-B. More or fewer spaces 64 b′ at different spacing may provide different angular adjustments of stapler device 110.

A method of operating end effector 100′ will now be described. End effector 100′ may be introduced to the body and advanced to the target site in a similar manner as end effector 100. Pawl 66′ is engaged with a space 64 b′ during insertion, so that angle α is approximately 0 degrees. Once end effector 100′ is adjacent the target site, the user may move actuation wire 40 b in a proximal direction by, e.g., pulling on actuation wire 40 b. Proximal movement of actuation wire 40 b may cause pawl 66′ to rotate about pin 66 a′ and disengage pawl 66′ from a space 64 b′ and teeth 64 a′ of sprocket 64′. After pawl 66′ is disengaged from space 64 b′ and teeth 64 a′, the user may orient stapler device 110 as desired relative to the tissue and/or target site in a manner similar to orienting stapler device 110 as discussed with reference to FIGS. 2A and 2B, e.g., by moving elongated body 50 in a proximal or distal direction, thereby changing angle α. Once stapler device 110 is properly oriented, the user may release and/or push actuation wire 40 b in the distal direction. For example, if pawl 66′ is biased toward sprocket 64′, releasing actuation wire 40 b may cause pawl 66′ to engage a space 64 b′ between teeth 64 a′. Alternatively, or additionally, a distal force applied to actuation wire 40 b may be necessary for such engagement. Once pawl 66′ engages a space 64 b′ between teeth 64 a′, stapler device 110 may be locked in the selected orientation and the user may perform additional procedures. For example, the user may then move anvil 120 from the open configuration to the closed configuration by moving actuation wire 40 a proximally and/or may perform additional medical procedures, e.g., stapling, cutting, or other procedures on the tissue. To change the orientation of stapler device 110 relative to pivot arm 60, pawl 66′ may again be disengaged from teeth 64 a′ and stapler device 110 may be rotated about the axis defined by pin 60 a as described herein. Locking mechanism 64′ of FIGS. 4A and 4B permits locking of stapler device 110 relative to pivot arm 60, independent of opening and closing of anvil 120.

A locking mechanism for an end effector 100″ according to another example is described with reference to FIGS. 5A and 5B. End effector 100″ is similar to end effectors 100 and 100′, e.g., may include stapler device 110 and pivot arm 60. The locking mechanism may include a ball-nose spring plunger 64″, including a housing 150 fixed to body 130 of stapler device 110. Ball-nose spring plunger 64″ may include detents 64 c″ (notches) disposed on a distal end of pivot arm 60, a biasing member 64 a″ (e.g., a spring, a threaded housing having a spring and a ball-bearing or a plunger, or any other biasing member) disposed in (or on) housing 150 and configured to extend out of a proximal end of housing 150, and a ball bearing 64 b″. Ball bearing 64 b″ is inserted within an interior of biasing member 64 a″ so that ball bearing 64 b″ is held by biasing member 64 a″, rotates relative to biasing member 64 a″, and protrudes from an end of biasing member 64 a″.

As described herein, movement of elongated body 50 relative to pivot arm 60 may rotate end effector 100″ about the axis defined by pin 60 a. Distal movement of elongated body 50 may increase angle α and may cause biasing member 64 a″ to be compressed within housing 150. For example, as angle α increases, stapler device 110 rotates about the axis defined by pin 60 a, which may cause the protruding material between detents 64 c″ (teeth) to push against ball bearing 64 b″, thereby compressing biasing member 64 a″ into housing 150. Biasing member 64 a″, ball bearing 64 b″, and detents 64 c″ may cooperate to lock stapler device 110 at different orientation angles α relative to pivot arm 60. For example, a friction force holds ball bearing 64 b″ within the corresponding detent 64 c″. As stapler device 110 is rotated about the axis defined by pin 60 a, biasing member 64 a″ is compressed until the friction force between detent 64 c″ and ball bearing 64 b″ is overcoming. Overcoming this friction force causes ball bearing 64 b″ to move from the first detent 64 c″ to a second detent 64 c″, adjacent the first detent 64 c″. Once ball bearing 64 b″ moves to the second detent 64 c″, biasing member 64 a″ expands back to the original length/position. Additional distal movement of elongated body 50 may cause stapler device 110 to pivot about the pivot axis defined by pin 60 a, causing biasing member 64 a″ to again compress. As biasing member 64 a″ is compressed, ball bearing 64 b″ is moved from the second detent 64 c″ to a third detent 64 c″, adjacent the second detent 64 c″. Continued distal movement of elongated body 50 causes angle α between axes A-A and B-B to increase. Alternatively, or additionally, the distal end of end effector 100″ may be pushed against tissue to provide additional leverage and assist in changing angle α.

To decrease angle α, a force on elongated body 50 in the proximal direction (e.g., a pulling force) must be sufficient to overcome the frictional forces between ball bearing 64 b″ and detents 64 c″. When the friction force is overcome, stapler device 110 moves relative to pivot arm 60 such that angle α decreases. The number of detents 64 c″ and the spacing between adjacent detents 64 c″ may be selected based on the number of possible positions stapler device 110 may be locked relative to pivot arm 60. A smaller ball bearing and smaller detents may result in finger adjustments of angle α and more options for angle α.

A method of operating end effector 100″ will now be described. End effector 100″ may be introduced to the body and advanced to the target site in a similar manner as end effectors 100 and 100′. End effector 100 is advanced to the target site in a closed position and is opened by actuation of actuation wire 40 a. During insertion, ball bearing 64 b″ may be engaged with a first detent 64 c″ so that angle α is approximately 0 degrees, e.g., so that axes A-A and B-B are approximately parallel. Once end effector 100″ is adjacent the target site, the user may rotate stapler device 110 about the pivot axis defined by pin 60 a by pushing elongate member 50 in the distal direction. The distal movement of elongate member 50 may cause angle α to increase and may cause biasing member 64 a″ to compress within housing 150. As biasing member 64 a″ is compressed from the original length into housing 150, a second detent 64 c″, adjacent to the first detent 64 c″, engages ball bearing 64 b″ and biasing member 64 a″ expands to the original length. Friction forces between ball bearing 64 b″ and the second detent 64 c″ lock stapler device 110 relative to pivot arm 60. The user may continue to push elongated member 50 in the distal direction until a desired orientation of stapler device 110 relative to pivot arm 60, e.g., a desired angle α, is achieved.

To decrease the angle α, elongated member 50 may be pulled in a proximal direction. Such movement causes spring 64 b″ to be compressed into housing 150, moving ball bearing 64 b″ from, e.g., the second detent 64 c″ to the first detent 64 c″. In this manner, the orientation of stapler device 110 relative to pivot arm 60 may be selected and locked. Locking mechanism 64″ of FIGS. 5A and 5B permits locking and unlocking of stapler device 110 relative to pivot arm 60, independent of opening and closing of anvil 120.

It will be understood that any of the locking mechanisms described herein may be used alone or in combination with one or more other locking mechanisms described herein.

While different medical systems have been described, it will be understood that the particular arrangements of elements in these fastening systems are not limited. Moreover, a size, a shape, and/or the materials of the fastening system are not limited. As described herein, there are included various locking mechanisms for maintaining an orientation of a fastening device of an end effector. For example, in certain procedures, performing various medical procedures may be improved by ensuring proper orientation of the end effector relative to the endoscope and, thus, relative to the target site/tissue.

It will be apparent to those skilled in the art that various modifications and variations can be made to the disclosed device without departing from the scope of the disclosure. Other embodiments of the disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims. 

1-20. (canceled)
 21. A medical device, comprising: an end effector at a distal end of the medical device, wherein the end effector includes a tab; an actuator coupled to a proximal end of the end effector; and a pivot arm pivotally coupled to the end effector distally of the proximal end of the end effector, wherein the actuator is configured to pivot the end effector relative to the pivot arm, and wherein the pivot arm includes a plurality of teeth and a plurality of spaces between the plurality of teeth; wherein, in a first configuration of the end effector, the tab is configured to selectively engage a first space of the plurality of spaces to lock the end effector at a first angle relative to the pivot arm, wherein, in a second configuration of the end effector, the tab is configured to selectively engage a second space of the plurality of spaces to lock the end effector at a second angle relative to the pivot arm, wherein the first angle differs from the second angle, and wherein, in the first configuration and in the second configuration, the end effector is restricted from pivoting with respect to the pivot arm.
 22. The medical device of claim 21, wherein the end effector includes an anvil and a body configured to receive a cartridge, and wherein the tab is coupled to the anvil.
 23. The medical device of claim 22, wherein, in the first configuration and in the second configuration, the anvil is in a closed configuration.
 24. The medical device of claim 22, wherein the anvil includes a pin, wherein the body includes a slot, wherein the pin is movably received within the slot, and wherein the tab is coupled to the anvil via the pin.
 25. The medical device of claim 21, wherein the pivot arm includes a pivot head, and wherein the plurality of teeth are arranged radially around a circumference of the pivot head.
 26. The medical device of claim 21, wherein the first angle is approximately 0 degrees.
 27. The medical device of claim 26, wherein the second angle is between approximately 30 degrees and approximately 90 degrees.
 28. The medical device of claim 21, wherein the plurality of teeth includes at least three teeth.
 29. A medical device, comprising: an end effector at a distal end of the medical device, wherein the end effector includes: an anvil having a tab coupled thereto; and a body pivotably coupled to the anvil and configured to receive a cartridge; an actuator coupled to a proximal end of the end effector; and a pivot arm pivotally coupled to the end effector, wherein the actuator is configured to pivot the end effector relative to the pivot arm, and wherein the pivot arm includes a pivot head defining at least one space; wherein, in a closed configuration of the anvil, the tab is configured to selectively engage the at least one space to restrict the end effector from pivoting with respect to the pivot arm, and wherein, in an open configuration of the anvil, the tab is disengaged from the at least one space, such that the end effector is pivotable with respect to the pivot arm.
 30. The medical device of claim 29, further comprising a wire coupled to the anvil, wherein actuation of the wire is configured to transition the anvil between the closed configuration and an open configuration.
 31. The medical device of claim 29, wherein the at least one space includes a plurality of spaces separated by a plurality of teeth.
 32. The medical device of claim 31, wherein the plurality of teeth are arranged radially around a circumference of the pivot head.
 33. The medical device of claim 31, wherein the tab is configured to selectively engage a space of the plurality of spaces to lock the end effector at multiple angles with respect to the pivot arm.
 34. The medical device of claim 31, wherein the anvil includes a pin, wherein the body includes a slot, wherein the pin is movably received within the slot, and wherein the tab is coupled to the anvil via the pin.
 35. A medical device, comprising: an end effector at a distal end of the medical device, wherein the end effector includes: an anvil having a tab; and a body pivotably coupled to the anvil and configured to receive a cartridge; an actuator coupled to a proximal end of the end effector; a pivot arm pivotally coupled to the end effector, wherein the actuator is configured to pivot the end effector relative to the pivot arm, and wherein the pivot arm includes a plurality of teeth; and a wire coupled to the anvil, wherein the wire is configured to selectively: (a) close the anvil, such that the tab engages with the plurality of teeth to restrict the end effector from pivoting with respect to the pivot arm, and (b) open the anvil, such that the tab disengages from the plurality of teeth.
 36. The medical device of claim 35, wherein the plurality of teeth are configured to retain the end effector at a plurality of different angles with respect to the pivot arm.
 37. The medical device of claim 35, wherein the plurality of teeth are arranged radially around a circumference of a pivot head of the pivot arm.
 38. The medical device of claim 35, wherein proximal movement of the wire causes the anvil to transition from an open configuration to a closed configuration.
 39. The medical device of claim 35, wherein, in a configuration in which the tab engages the plurality of teeth, the tab is received within a space between adjacent teeth of the plurality of teeth.
 40. The medical device of claim 35, wherein the plurality of teeth includes at least three teeth. 